Journal of orthopaedic trauma
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Comparative Study
Early surgical stabilization of flail chest with locked plate fixation.
To compare the results of surgical stabilization with locked plating to nonoperative care of flail chest injuries. ⋯ This study demonstrates the potential benefits of surgical stabilization of flail chest with locked plate fixation. When compared with case-matched controls, operatively managed patients demonstrated improved clinical outcomes. Locked plate fixation seems to be safe as no complications associated with hardware failure, plate prominence, wound infection, or nonunion were noted.
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To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. ⋯ Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results.
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Fixation plate positioning remains controversial in clavicle fracture reconstruction. Biomechanical studies favor a superior plate placement and clinical series report very low mechanical complications for anteroinferior plate placement. To clarify this apparent discrepancy, a biomechanical finite element analysis of the deformation mode, stress patterns, and peak stresses involved with superior and anteroinferior clavicle plate fixation was performed. ⋯ Anterorinferior plating is generally preferable, because it induces deformation modes similar to the intact clavicle and is less likely to fail during normal physiological loading (cantilever bending). Superior placement of the reconstruction plate may be recommended for a patient with a high risk of shoulder impacts (axial compression). Design improvements in the bridging area of the plate and special attention to obtain a good fixation around the fracture could reduce plate failures and provide a stiffer construct.
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Randomized Controlled Trial Comparative Study
Are polyaxially locked screws advantageous in the plate osteosynthesis of proximal humeral fractures in the elderly? A prospective randomized clinical observational study.
To evaluate the results of plate osteosynthesis using either polyaxial or nonpolyaxially locked screw-plate systems in proximal humeral fractures in the elderly. ⋯ Both the functional outcomes and the rate of complications after polyaxial locked plate osteosynthesis of proximal humeral fractures in elderly patients were comparable to those treated with nonpolyaxial implants. Despite the theoretical advantages of polyaxial locked plating in proximal humerus fractures, this study could not show a verifiable clinical advantage of these plates.